Patient perceptions regarding the risks of morbidity and complications of lower third molar removal

The risks associated with third molar surgery are well established. Current philosophy stresses co-development of treatment plans with patients, who need to understand the complications and risks of possible treatment. This understanding was therefore investigated at an initial outpatient appointment (n = 91) after a verbal explanation and immediately prior to surgery (n = 73), by means of visual analogue scales to assess patients' perceptions of the likelihood of each outcome. Most patients (98 percent) responding at an initial appointment (t1) felt that they had been given enough information regarding reasons for removal but the proportion was lower (88 percent) for patients responding at the time of surgery (t2). This reduction was also found for information regarding post operative pain, swelling, trismus and nerve damage. Patients estimated the likelihood of pain as t1 = 70 percent, t2 = 80 percent, swelling t1 = 76 percent, t2 = 75 percent, trismus t1 = 74, t2 = 73 percent, temporary nerve damage: transient labial t1 = 46 percent, t2 = 33 percent, transient lingual t1 = 51 percent, t2 = 41 percent, and permanent nerve damage: labial t1 = 13 percent, t2 = 7 percent, lingual t1 = 14 percent, t2 = 9 percent. At t1 and t2 the mean perceived likelihood for pain, swelling and trismus were significantly higher than the known prevalence of these sequelae. The mean values for temporary lingual and labial anaesthesia were considerably higher (P < 0.05) than the reported prevalence. It was concluded that patients overestimated the likelihood of post operative complications and that these estimates varied with time. The validity of patients' estimates might be improved by verbal explanation supplemented by provision of written information.